Brain Health by Decade - Cognitive decline conversation that needs to happen

All right, welcome back to Cell to Systems episode 14. In this episode, we have a returning special guest, Robin Steagall, who is a registered dietician, a nutritionist who's focusing on high performance athletes and people who want to maximize their lives. Today we're going to talk about a topic that's on everyone's mind, no pun intended, and that is cognitive decline. And what's super interesting about this is that we think of dementia as a disease of age, but it's actually a disease of decades. We're going to talk about all the things that we can do to prevent dementia or cognitive decline and however it shows up as we go through it.

Some of the things that are kind of interesting are the topics that were in a 2024 study that showed that you could start to work on this stuff pretty early on in life. Lack of cognitive exercises, so some form of education, health, hearing impairment, untreated vision loss, a high LDL cholesterol, traumatic brain injury, obesity, diabetes, lack of physical activity, hypertension, smoking, excess alcohol consumption, air pollution, depression, and social isolation. No surprise. You know, I'd love to see what you think about this one as we kick it off. Robin, you just came back from a training that was relating specifically to this nutrition and cognitive decline. So, it's kind of interesting. What can you bring to the group?

The conversation I was listening to is coming out of the tactical athletes, our tactical first responders, our sort of first responders and frontline defense in the military. And when those individuals need to show up, they're showing up under all of the conditions that do not support necessarily optimal brain function, which is generally stress. Oftentimes there's a lot of time or flight delay. There's exposures to environmental pollution and toxins and things like that. And there is often a you're not showing up perfectly fueled, that sort of in the middle of the night that sudden call.

So, we want to look at how in these individuals are you making sure that in those moments of when they need to perform, how do you support that? And it was really interesting to see how those strategies for supporting those individuals throughout their career from when they enter the academy, you know they're 18 to 22 for example, and then how that changes through each decade and as their different factors start to come into play in terms of their hormones. How that overlaps with peak levels of their professional responsibility, you know, so their hormones are changing right as those peak levels of professional responsibility or tactical expertise are also peaking, and so just some of the interesting strategies that we can employ for those moments of performance.

The other thing that came out of it was just how essential it is to keep in mind the integration between the brain and the body when we are caring for the brain and optimizing cardiometabolic health. We're doing the same thing for the brain. And that's one of the key takeaways is when we're in the nutrition field working on our cardiometabolic risk factor mitigation, those factors are also improving our cognitive performance throughout the life cycle.

Fascinating. Leonard, lead us in the right direction, man.

Well, I mean, we're talking about the brain, so we can go in any direction really. The long list that you mentioned just shows you, you know, how it's integrated with just about everything. I would say that in my experience what I found interesting, especially when I was first studying peptides, was that there was a lot of cognitive enhancing peptides. But my experience wasn't that the patient was coming back and saying, "Hey, that cognitive peptide was like the thing that lit me up and gave me clarity and made me feel better."

When I was getting the best response from patients, it was the patients that were coming in for weight loss or metabolic health or performance. Those were the patients that were telling me the most, "Hey, my brain's working better than ever before." Once they started getting on a good plan, they were exercising really well. They were getting after it when they're not only their nutrition, but they're just exercising better. And without asking, those are the patients that came in and said, "I am on fire right now. I'm clearer than I've ever been. I'm like firing on all cylinders."

And that's when I realized that the best strategy to cognitive health is through what Robin was talking about, is through metabolic health. And so it was other peptides like GLP-1s that were not necessarily doing a ton in the brain, but it was that it was helping them exercise so much better and recover from that exercise so much better that it was really making an impact on their clarity. And so I thought that was really eye opening for me, that it really all just stemmed back to metabolic health, which is where we always end up on this podcast. We talk about nutrition, metabolic health, and sleep. And so not to sound like a broken record, but we always end up there. But that's my experience. That's what's working.

Yeah, definitely true. And I wonder at new HX, I mean it must be really interesting when you think about it like you're seeing patients pretty early on. Christie, you always talk about treating patients by the decade. I'm curious what your thoughts are on this as you've seen actually, and I think you've had something kind of personal with regards to this.

Just kind of what Robin and Leonard have both... I mean we can't separate the brain health from cellular health. I mean the brain is one of the most metabolically demanding organs in the body, and when mitochondria struggles, cognitive health struggles right along with it. And you know, most patients' traditional providers wait until memory loss is obvious, right, and before they even start thinking about brain health. However, I know all of us as longevity providers, I mean we're asking a different question, right? How do we preserve this cognitive resilience decades before it even starts?

And you know, sadly so many patients, they joke about brain fog and I kind of throw it back to them. I was like, "You know, brain fog is not a personality trait." I mean it's often a signal that the brain is underpowered, inflamed, hormonally unstable, and metabolically stressed. Cognitive decline is not just about aging. It's that compound effect of inflammation, metabolic dysregulation, poor recovery, toxic burden, sleep issues, and loss of energy over from a cellular perspective over time.

And then you know, everybody comes on these... and I think it's getting less and less, but so many people, they try to outsupplement a nervous system that's chronically under stress. Like, we have patients that come in that are on 20-some plus supplements, and the brain is constantly adapting to the environment we create through sleep, movement, blood sugar regulation. I think you know, like what Leonard was saying, we've seen this firsthand with GLP-1s, what they do as far as with the blood sugar regulation, the hormones, and relationships as far as when we can create that brain adapting to that environment.

But one of my biggest motivators for longevity medicine is not about extending lifespan. It's the process of preserving identity for the patients: memory, that emotional regulation, and then the ability to fully engage in life and then have the ability to live healthy.

And you know, for me personally, we just can't have a talk about brain health without addressing hormone optimization. I mean hormones are neuroprotective, and when hormones are optimized, our brain processes stress differently. When female patients complain of being tired but they report poor sleep, I know that's their hormones are off, and you know, it is kind of that "tired but wired" feeling that I will explain to them.

And then the other system is, you know like Leonard said, we always go back to the mitochondria, the health of the cell. And cognitive health is so deeply tied to the mitochondrial efficiency because the brain consumes an enormous amount of energy. And the brain is also incredibly energy sensitive. Stable blood sugar is one of the most underrated cognitive optimization tools in my opinion. And I'm so thankful like our community, we're talking about that tie to why we're seeing this cognitive improvement with people that are on GLP-1s, of how it's creating better cognitive health.

And you know, I think just out of respect for Dr. Fury not being here, I mean, a dysregulated nervous system can mimic almost every cognitive complaint we see in practice, right? I mean, you cannot build or maintain a healthy brain in a constant fight-or-flight state. And I do think there are some few key essential nutrients and supplements that I recommend for all my patients: vitamin D3, methylated B's, a good omega, magnesium, ketones, and creatine, which I know Frank is all about his creatine. But I think we all understand what that does.

And if I have further concerns for a patient's cognitive health, I mean I will do a deeper dive as far as with the prenatal scan to really look at more deeper deficiencies. But you know, I guess it always comes back, you know, my goal as a longevity provider is not simply to avoid this dementia. I mean the goal is to maintain the clarity, the purpose, that emotional relationship stability, and performance throughout life. And just like Robin was saying, I mean, we can't have a high-performing life or lifestyle or job with a low-performing brain.

One of the things I've noticed because where patients intersect with me or clients intersect with me is different. They're coming in to me for this specific optimization around this input in their life, and then they just get as a bonus guidance around, you know, recovery and activity and things like that because that really is how you're going to activate the benefit of your nutrition, right? You can eat as well and clean and whatever as you want, but if we're not moving it, then we're not changing the... I like to describe it as the temperature of the oven in which all those ingredients are going to be utilized.

So one of the things that I find interesting with an increase in the number of people that are on GLP-1 medications, even at like microdosing levels, is the fact that it starts to alter some of the habits that are cognitively protective. Specifically, I start to see decreases in people's hydration strategies, like they're not hydrating enough. I noticed I started to get a little bit concerned about like how quickly they've lost weight, micronutrient deficiencies, because these are things that also underpin cognitive protection for prevention and also cognitive performance immediately.

The other thing that's really surprising me is we can fight inflammation, yes, but we also sometimes have these mood shifts that we're sort of maybe not considering the fact that these individuals are basically underfueled. They're on GLP-1 medication. The brain is a huge calorie hog, right? And they're filling their bodies with protein and they're not hitting the carbohydrates that their brains desperately need for maximum performance.

And so by the time a patient comes in to see me, if we've optimized for hormones, we've optimized for all the other factors, I'm going to start looking at these things if we're still seeing brain fog or they're just missing words when they're making a speech or a presentation or something like that. If they find that their motivation is slipping for workouts or for training, then that's where I'm going to start to look in terms of the mind and the brain effect of some of these other factors that can have a negative influence on cognitive performance and cognitive health.

Hey Craig, I'm curious in your practice, have you ever had a patient come in who's already in cognitive decline and you're trying to actually work with them to improve where they are? So, you know, that person that comes in and like, "Hey, I keep losing my keys and I can't remember this and I can't remember that." It's beyond, you know, brain fog at that point.

Yeah. I mean, I don't think that I've had anybody in overt dementia state or anybody who's really struggling to such a severe degree that, you know, they would go to their primary care or some other clinic and be diagnosed as having some neurodegenerative condition or dementia or something of that nature. But certainly it's relatively ubiquitous across the board that people are having complaints of fatigue and poor cognitive reserve and resilience and so forth.

So it's something that we're addressing all the time through the modalities that have been mentioned here thus far in terms of nutrition, making sure micronutrients are optimized, making sure hormone levels are balanced. I also tell people—and sort of coming back to what the throw is going to be at the end of this conversation—you know, the brain is a muscle in and of itself. It's use-dependent. It's adaptive. It's trainable. Right?

So nowadays when we're faced with all these different distractions and things that sort of make processing so much easier and whatnot, it's easy to sort of fall out of the habit of flexing that muscle, right? We need to constantly do things that are going to challenge the brain, things that are novel, things that are going to promote learning, promote synaptogenesis and the formation of new connections between neurons, you know.

So for somebody in their 50s, like, one of the best things that they could do is maybe try to learn a new hobby, whether that's picking up an instrument. We've heard these things for years and years and years, but actually going out and doing it is a whole other thing. So, we also want to emphasize consistency, right? It's those small daily repetitive behaviors that are actually going to move the needle and preserve cognitive resilience for decades to come. So, it's got to be consistent. It's got to be focus-driven and, you know, it's the type of thing that anybody can work to improve when they're looking to optimize their whole body physiology. I mean, trying to focus on brain health and doing everything that we can to preserve our mentation and mental fortitude is something that's not beyond anyone.

Yeah it's amazing. You know what? It's interesting, Frank. When we talk about like playing tennis, you know, I play a lot of chess and I think that's been something that's always challenged me in a big way. But you think about playing tennis, it's kind of interesting because it's so mental and it's so physical at the same time. I wonder how people in South Florida who play a lot of tennis do cognitively compared to people who live in, you know, someplace else. You think there's any advantage to that?

I think there's an advantage for anybody that's actually just moving in general. By the way, down here now is pickleball. Unfortunately, the tennis players are gone. They're getting kicked out of the tennis courts by the pickleball people. But yeah, there's an advantage to that, you know, and absolutely.

It's funny because for me, this is very complicated, this brain talk, because it's almost like a nuance for me. As a pharmacist, I always want to have a pill, right, for everything. But as I'm spending more time talking to people about brain health and looking at my parents getting older, what I'm seeing is, you know, maybe what if the pill is not the answer, right? What I've seen in the past and what I'm looking at is—kind of aligning with what you're just asking me there, Jock—the people that are moving the most, the people that are more active, the people that have a social connection to people, to things, seem to be the ones that are doing better or are delaying the inevitable, like delaying the symptoms or tend to be happier in general, right?

And I'm seeing that, you know, as we are spending more and more time talking about pharmaceuticals, peptides, supplements... a lot of time, a lot of physicians out there are not spending the time talking about the most accessible thing people can do, which is exercise, and their ability to spend more time sleeping than anything else, or doing things they actually enjoy doing. Because this accessibility is easier, and it's got the most amount of downstream effect that's going to help people even better once they start taking medications, right? Because they'll be better optimized to actually receive those drugs to amplify the outcome that the drugs are supposed to be doing.

So yes, in general, people that are exercising, playing more sport, playing more tennis—which is a social event, talking to people—they seem to be doing much better when it comes down to cognitive health in general, or they seem to be better at showing less decline over time, you know. And I think that's really where the first step is. What Leonard was talking about earlier is just like the people that start a commitment to any type of exercising or exercise protocol in general, or nutrition protocol in general, tend to be the person actually doing better and saying that their thoughts are a little bit more clear or they're motivated again. Right?

So that's the first thing, you know. And the second part of it, obviously, is everything that we're seeing around Alzheimer's because we talk about GLP-1s there. We used to talk about type 3 diabetes with the brain, you know, and the incidence obviously of Alzheimer's in this century correlated to an increase in weight gain in general. I think that's a merit that we also need to kind of dig a little deeper in there because I would love to see what the data is going to look like in the next 10 years on the entire world on GLP-1s, and really kind of seeing how it's going to really change the numbers when it comes out to Alzheimer's prevention in general.

Because it's true, the brain is almost another metabolic organ that's probably fueled on glucose, I'm sure. So when you have insulin resistance throughout your body and your brain becomes insulin resistant, I'm sure you're having the same problem in your brain. So by looking at GLP-1s, I'm curious to see as things are going to change there. And I'm curious to see also what you guys have to say about that. Do you think that the GLP-1s are really going to be the one there at decreasing the incidence of Alzheimer's in the world?

Well, have you guys heard about the MIND diet study, which is the Mediterranean diet, and it's an intervention for preventing neurodegenerative disease? The thing to pick up on something Frank was saying about pickleball is the fact that in Mediterranean countries where they're following this Mediterranean diet, the lifestyle is part of the diet. So we talk about it—it's movement-based first. It's communal, you know, deep interconnection. So you have these social networks. It's a plant-heavy or plant-forward diet with these really good fatty acids from olive oil and fatty fish and things like that. But physical activity is integrated within that diet. It's a dietary approach or a lifestyle that seems to be protective.

And the other thing that was interesting coming out of the MIND diet is even moderate adherence had a dramatic improvement down the road at reducing your outcome of developing Alzheimer's disease or whatever. So it's almost the benefit... and where I try to work with my clients on is the fact that being consistently better will beat being perfect occasionally when we're thinking about these kinds of interventions. And so being physically active, having that community around you to participate in social sports or to play chess with or whatever is actually part of the whole sort of lifestyle pattern that we're trying to encourage.

Because sometimes too—and I think we had spoken about previously—the rigidity of trying to find the supplement or find the specific sauce, the magic ingredient to get us to almost hack our way into prevention of cognitive decline or optimize cognitive performance, that in itself can become discouraging for people. They feel kind of that, "Well, I blew it," and I see that frequently coming up for patients. I was just wondering if that's something that you guys have noticed too in terms of when clients are coming to you? Are they... do you see them getting kind of locked into that thinking around these things? Is there like an all-or-nothing approach that you guys kind of work with them on?

From a pharmacist perspective, there's a couple things that I've noticed where it has nothing to really do with their cognitive decline. Like in pharmacy, there's a lot of overprescribing, right? And so, one of the things we used to run into a lot is that there's a lot of anxiety in the world. And unfortunately, a lot of physicians, you tell them you're anxious, of course, you know, you're sedated and you feel a lot better. And as patients get a little bit older, you think that they are going through cognitive decline and it's just medication-based.

Unfortunately, there's some really sad stories of people never even understanding that and being misdiagnosed with cognitive decline and neurodegenerative diseases, and all of a sudden their families start treating them differently, and it was all due to a medication side effect. And so I've seen situations like that, and I've also seen situations where people are just under a lot of pressure and anxiety with work and life, and they're just so inside their head that they tell me... and I have had this myself. This is probably why it's so clear in my mind.

I have to go into the garage for something. I get to the garage and I don't remember why I'm there. And look at Jock, because me and Jock have similar brains. And because you're just so involved in your head and you're so intense of what you're thinking about. And that happens every once in a while, but there'll be situations where it's like this has just happened like three or four times in the last hour. And it's very situational.

So, there's got to be a little bit of investigating of what's going on in that person's life with work, with life in general, because a lot of it can stem from this isn't really cognitive decline. It's something else in their mind that's gotten so kind of overwhelmed. Or, the way that I describe it is that when you're having thoughts about one thing, it connects to another thing and it connects to another thing. You think about work, but then you're thinking about the person, you're thinking about your finances, and it's just like everything's connected. So, you don't even have time to process the real problem in front of you, thinking that they have cognitive issues, but it's really just an anxiety that just wasn't treated.

So, yeah, there's just like a lot of angles to this cognitive function thing, but I find that most of the time we don't run into that patient that has like true neurodegenerative disorder that's creeping up on them, and it's just life. It's trying to figure out life, which is what we're all trying to do here.

You know what, Leonard? What's funny is that one thing that I remember back in the days on the bench working in retail pharmacy—it is pretty clear and anybody can look at it now, Google it, whatever they need to be doing—one of the number one side effects of long-term use is cognitive decline, and it's actually stated so. Think about how many millions of people live in the United States, and so imagine a compounded effect that we're going to start having in the next couple years here. But that is to me a sign of what's to come, mixed together with everything else that we talked about, right? Lack of exercise, AI, stress, and everything else that we talked about. So, this compounding effect is going to be very interesting to watch here.

Back to something Frank said, and that was the GLP-1s, you know, how will the GLP-1s affect neurocognitive decline? I'm curious what Craig and Christie think with regards to that.

I mean, I think that they're going to be huge, right? We know that they are just incredibly impactful, and if you look at some of the studies, actually there was a study that came out from the International Alzheimer's Association, I think it was in 2023 or 2024. And it was actually looking at one of the earliest GLP-1s which is liraglutide. They used liraglutide in over a million patients who had modest or mild to moderate Alzheimer's dementia, and they followed these people for over a year and they found that there were significant reductions in the rate of cerebral atrophy in these patients. They found that there were significant reductions in the rate of cognitive decline. There were improvements in glucose homeostasis within the brain that was measured on imaging, and we associated reduced toxicity actually with these hallmark proteins and biomarkers, you know, the amyloid beta protein, tau.

So you know, I think GLP-1s are going to be absolutely huge. And just to sort of recap what everybody said, you know, anything that's ultimately good for the heart is good for the brain. If we're driving oxidative stress signals through insulin swings and glucose volatility and inflammatory cascade, then, you know, obviously we're going to have repercussions of that in the brain and central nervous system.

The same is true—and all of these things are related, right?—but the same is true for like management of blood pressure. We know that GLP-1s have a positive influence on individuals' blood pressure, and prevention of hypertension and regulation of, you know, normotension patients and maintaining normotension rather is critical for improving brain health. I think, again, just looking at the large conglomeration of all of these things, an area that I think is particularly fascinating is how GLP-1s are ultimately going to influence things like depression and anxiety. These are things that are listed in the pamphlets and whatnot for these medications, that they can influence neurotransmitter status and things like that. And we know that depression and hopelessness and feelings of connection are very much going to influence somebody's risk for dementia. So I think that they're going to be huge. There's going to be net positives.

There's going to be things that we need to examine further, but you know, GLP-1s, as far as I'm concerned, are a big win. I mean, just look at like—totally off topic—but there was some research that shows that there's like reduction in cancer risk for up to 50 different types of cancer. It's just pretty crazy, I think. And I think we're going to see a lot of net positives from GLP-1s as far as cognitive well-being and preservation go.

I mean, I agree. I mean, stable blood sugar without a doubt equals an optimized brain health, cognitive health. You know, I think the population in your neurovascular disease as far as with your Alzheimer's, Parkinson's, your MS... I have a handful of those patients and I mean, they do wonders on just a low dose of just even their movement ability.

And then I have like this one patient in particular right now that's unfortunately got another plaque with her MS, but we just upped her... I mean she's on a very, very low dose and she's already seeing symptom improvement by just increasing the GLP-1 by I think by 1 milligram, because she's already a smaller-frame lady, so did not want to get any kind of appetite suppression for it. But her mobility, her cognitive health within a month is already improving.

So, so cool. If you think about all of this, everything that's happening in this time, it just feels like we're sort of at the pinnacle or like the beginning of something that's just really expansive and the knowledge that's available to people out there today. Imagine, I mean, if you're in your 20s, you can really probably avoid a lot of these issues. And it's pretty exciting. I can't... I mean if you think about it like 10 years ago, what would Leonard... what would we do? People didn't have this kind of information 10 years ago, did they?

No. They just had the stuff we always talk about. They had Robin before, and look where that got everyone. Oh my gosh. Seriously.

Hey, listen, I got to tell you, I think the people that are working with you are doing pretty well. Yeah, it is a systems approach. I wonder... I mean, I don't know if there's data out there, but like is the population getting more metabolically healthy? Are they getting thinner? You know, are they? I'm not sure.

Yeah, because you know, I see people still struggling a lot, and I see people yo-yoing a lot when it comes to GLP-1s. And I see people that the scale looks a little bit lower, but they've lost a lot of muscle. I mean, same conversation that we've always had. And their nutrition, I guess calorically restricting, even if it's bad, is better than what they were doing before, maybe. But yeah, I wonder about this question. I think it's a net positive for sure, but there's just so many other factors when it comes to mental health, like the other ones that we were talking about, not the predisposition to neurological diseases. That's, you know, we can delay the onset of that or maybe even eliminate it, but I think that when it comes to cognitive function, we're going to need more than GLP-1s because GLP-1s are showing good stuff in neurodegenerative diseases, but cognitive function and brain fog is a bigger topic than just the disease state of neurodegenerative diseases. So we need more than GLP-1s.

When I would say, you know, just to get back to the like where were we 10 years ago and what do we know now that we wish we knew then? I want to touch on the gut microbiome. I mean, 10 years ago, I just vividly remember talking to my pediatrician about giving my C-section baby some probiotic support now that he's in the world. And they looked at me like I was literally trying to perform witchcraft. I mean, it was insane, you know, and now, it's like, wow. Oops.

So, what I think we have the benefit now and what we can do with our 20-year-olds now is frontload this information about protecting these vital resources within your body. You know, if you're on a GLP-1, one of the things I struggle with is y'all eat more plants. You got to eat those plants. You need those prebiotic fibers in the body. And it's really, really hard if you're dosing maybe too high of a dose. So, it's like really working to help them find the balance point.

And a lot of people that are using them with like suboptimal outcomes are usually not partnered with a team. You know, in my experience, I end up getting some of those folks that come into my office and they've been doing it because they got it at like a med spa or something. Nothing wrong with that. It's just you really need to make sure that whoever you're working with as a prescriber can also put you in touch with someone that can support your microbiome, that can support your protein and fiber intake and things like that. But I really feel like in terms of cognitive health, the connection of the gut and maintaining that microbiome is something that we really are benefiting now and able to communicate earlier and to a larger audience.

Yeah. You know, I made a post that people are still arguing about on Instagram where I said doctors should be thanking Jim Bros for peptides. And the reason I said that is just because they were using it far before that. And we can extend this to dietitians, nutritionists, just anybody outside of the medical community that was talking about resistance training, muscle, fiber, protein, exercise like a long, long time ago. And now it's the cool thing for physicians to be talking about it. And so it just reminded me of your story about talking to the pediatrician about probiotics and, you know, so it's we have to listen outside of our community.

Well, and to be curious and not immediately reject out of hand something that seems new. I mean, and oftentimes it's... and I think your post is actually not that far off in terms of it's not necessarily gym bros they need to thank, it's the whole area of like human performance and physical optimization and pushing the needle on what the best practice guidance is. Because what the best practice guidance has done is essentially not New York... necessarily move the needle on making us as a society healthier. If anything, we've lost ground until recently, I feel like.

So you know, that's a big statement, but I mean you guys know what I mean in the fact that, you know, going to a pediatrician as a new mom and saying, "Hey, I would like to try these probiotic drops in MCT oil for my infant," and they just... how could you do it instead of approaching it with curiosity? And I feel like when patients come to providers that are integrative and working on optimization, they are much more likely to meet a provider who will listen to them, take their case individually, and really meet their questions with curiosity and help them create a solution designed for them as opposed to just right out of pocket, "Nope, don't do it," you know. And that's discouraging and I think we lose ground with that. So, I like your post, Leonard. Yeah. Woohoo.

Yeah. It's funny, Leonard. You know what? You did that post and like I think two days before that, I had done a post where I was talking about this lady in the gym who came up to me and asked me if I had the hookup for the peptides. And I'm like, "No, no, I don't." And at the end of it, I said, "The last place you want to be buying peptides is from the dude in the gym. Don't do it." And then you came out with that post. I was like, "Oh, man. Here we go. Thanks, Leonard."

It opened up some really great conversations in there. There was a PhD researcher that was talking about drug development from her perspective on the use of peptides. And there was a physician that says, "I will never prescribe anything that's not FDA approved." And there's a lot of great back and forth about, you know, there's this middle ground where, yeah, we shouldn't be buying peptides from the gym, but you as a physician should be... if your idea is saying, "I will never prescribe something that's not FDA approved," that's just telling us that you're... I love when people make that comment.

Yeah. But it opened up a great conversation and that's what I was doing it for because what I noticed about at least social media is that it could be really irritating going back and forth with certain people. But the majority of people are just listening and reading. And so if a doctor says something like that, there's probably a lot of other doctors that think that way also, but they're not going to be so brash about it and post it online, but they are going to listen to the responses and it will change the way people think. It's just the people that are reading and lurking around. But I do think it makes a big impact, but it is kind of frustrating and hard to keep it cool.

It's so true. If you just look at the views versus the comments or likes, you can tell tons of people are seeing this stuff and you look at the analytics of it. They're watching it all the way through, but they're just not saying anything. It's kind of interesting.

All right, this is a time for us to get ready to wrap it up. So, we're going to do this little piece here where we're going to go by Christie Fury's decades. We're going to start off with the 20s. And Christie, you're going to take the 20-year-old. What do you say to somebody who wants to optimize, wants to avoid cognitive decline, who's in their 20s and they just showed up in your practice?

So, for me, the first thing I'm going to do is, you know, just ask, you know, what is their opinion of health? I mean, what does health look like to them? Because what health looks like to a 20-year-old is going to be different than what health looks like to a 40, 50, 60, 70-year-old, right? And so just getting their understanding, their basis of what is health and how do they want to live their life? What's important to them? Is it making a lot of money? Is it having relationships? What is that driver for them? And that's how I kind of start, because that's usually where I will... whatever their driver is, whatever their motivation is, that's my hook. That's what I'll go into.

And, but you know, obviously making sure that they understand what muscle does for us and why muscle is—I mean, we've all said—our biggest currency. I mean, you cannot have health if you don't have muscle. You know, if they're not a gym person or if they weren't an athlete in high school, it doesn't have to be this strenuous activity that they don't enjoy. I mean, find something that they enjoy, even if it's just using some band workouts, just starting somewhere.

And then looking at food cuz, you know, like I mean my daughter, she's 17. If there's one thing that frustrates me as a parent is this generation, they have never grown up without processed foods and their idea of what food is is not what our idea of food is, right? I mean because they they've literally... I mean, my daughter, I had her in daycare and so I mean she was fed those goldfish stuff and everything that we know is not food. But so I mean making sure they understand.

And then like an analogy I use a lot just cuz they usually laugh about it but is, you know, if it's not picked, pulled, or killed, you probably shouldn't be eating it. Like just keep food that simple and you're going to be okay if you look at food that way. And then I am a fan of—because it doesn't take a lot of money—being on a vitamin D3, a magnesium, and an omega, like just those three simple things, prioritizing the importance of exercise, and sleep is where I start. And again, once I understand what their motivators are.

Hey Christie, before we move forward on the D3, do you need to pair that with K2?

Yeah, and the K2. Yeah, just double checking. All right, Leonard, you've got the 30-year-olds.

The 30-year-olds. Okay. What 30-year-olds are thinking about cognitive function and decline? Maybe some are nowadays. If someone came in talking to me about that, I'd first be talking and asking about a really great assessment, even family history, because I think it's going to be metabolic health. And so what are you more predisposed to if you want to go as far as genetic testing, or if you want to go as far as just family history? What are you more predisposed to when it comes to metabolic health, cardiovascular disease, neurodegenerative diseases? Because it's going to be all about optimizing that, and it's going to be based on optimizing metabolic health and exercise capacity. And I think those are the things that are just going to make the biggest difference.

And then I will tell them a story about... I played poker a lot with some old-timers and there was always this one story that just stuck in my brain forever, which was somebody in the poker room had just died—they had dementia, some neurodegenerative disease—and all of them were talking about all of their friends that play poker. It was a kind of a morbid conversation about how they passed away because they were a little bit older.

And what they noticed around that poker table is they realized that everybody they've been playing cards with for a long time had passed away of different diseases, but none of it was neurodegenerative diseases. And they all had other friends outside of their poker community that had died from neurodegenerative diseases. And that always stuck with me, and I started actually looking up studies, and it did show that if you are playing board games and doing things like poker and strategy games and keeping your mind active... so that always stuck with me and I'm always trying to think of something new or learn something new, something that I'm not used to doing. And if cognitive decline or optimizing cognitive function is something that's important to them, I'm just telling that story so that they can start thinking about just always trying to learn something new.

That's awesome. Yep. Robin, you've got the 40s.

Oh boy. So, client in their 40s comes into my office and what do we talk about? So, first of all, the thing I find interesting about the 40s is generally that's where we're starting to peak in terms of a lot of our responsibilities in life: our caregiving, career, performance, also our economic sort of wherewithal is also increasing. And so their ability to start accessing and looking into some of these other optimization strategies is also starting to really come online.

I typically sit down with those clients and I say sleep like your life depends on it. We need to sleep now because you have a lot more margin in your 40s than you have in your 50s. So we want—even though you don't feel as rough about it—sleep now. You're banking. This is... you're just banking margin. Please really prioritize sleep.

The second thing is I give them the big three in terms of every time you're fueling, I want to see plants. Plants, colorful plants. We need something dark, leafy green, colorful fruits and berries, oranges, yellows, all the things. Plants, protein, healthy fat. Those are your key three on a plate, at a snack. And you want to make sure that you're doing that as frequently as you can throughout the day. Don't get weird and obsessive about it, but really be mindful and focused.

The final piece of advice I give them is strength train. Men, women, please hit the weights. Hit the weights. If we can build, maintain and create that sort of internal physiology around muscle strength, muscle development, we are doing so much in terms of protecting the cardiometabolic state of our bodies, cognitively and physically. We're improving insulin resistance and all the things. So, strength train, protein, plants, healthy fats, and sleep like your life depends on it.

Robin, you know, at the risk of really throwing this whole thing off track, I just got to hit this really quickly because there's been a lot of talk over the last 10 years around diet. And there's been one doctor or a couple of doctors that have been big proponents of no plants in your diet at all. Yeah, and I was just wondering how wrong they are.

Well, they're desperately wrong, and I feel sad for folks that are following it. And so, what do I mean by desperately wrong? I'm looking at all the kinds of things that we get from plants in terms of the protection of the gut microbiome, the prebiotic fibers. We're looking at all the phytonutrients that are coming online. We need plants.

The other reason why no plants... that also means no carbs. And we also know that carbohydrates are important in terms of the energy systems in our body and our ability to make muscle, our ability for our brains to perform and work, and carbohydrates are the coin of the realm in terms of energy production in the human body. I think what they can do when they get really extreme in any of their advice is they can get a lot of attention and they can make money for a while, right? So, it's that angle of, "I'm going to give this really kind of interesting take."

But I will tell you that we evolved as creatures on the planet to eat plants and animals, and the societies that follow those balanced diets are the ones that typically end up with the best outcomes.

Thanks for the supplemental. Craig, 50s, let's go.

All right. Well, to keep it short, I'm gonna say I think Leonard's spot on with learn a new skill. Flex that muscle, you know, and it's challenging. It's going to present difficulty for a lot of people to learn a new skill set in their 50s.

But it is going to drive synaptogenesis and the formation of new connections between neurons, and that's really important. And so whether it's a physical skill, whether you're developing aptitude in some other aspect—maybe it's a mental skill set as opposed to a physical one—just work consistently on improving your overall neurocognitive ability.

And the other thing to dovetail on that is like strategic thinking, right? Don't be your own biggest impediment to shifting perspectives, being open to new ways of thinking about topics and people and things. Be open, you know, challenge yourself to thoroughly evaluate and analyze things that maybe you didn't in the past. And I think that these will serve people well in that decade.

I love it. Moving on, Frank. You've got the 60s.

All right. Well, 60s. Yeah. Well, in the 60s, it's the story of the past 40 years that brought you into my office, right? How well you've been taking care of yourself for the past 40 years is how well you're going to be right now. And the good thing is that for most people, they're going to have a chance to reverse what they've done for the past 60 years, 40 years. And knowledge is key, right?

And the focus is going to be on making sure that they're moving, they're exercising. They have a driving force every day when they wake up. And that's nothing to do with medication; it's got to do with everything else inside them.

The second thing is understanding the process of inflammation, and that bad inflammation can become... as you're getting older, doing everything you can to decrease inflammation, which is by eating right, right? And making sure that you're sleeping right, right? That you're decreasing stress.

The third thing I want to tell them to work on is hormones, right? You know, you're never too old to take hormones. Where's your testosterone if you're a man? If you're a woman, where's your testosterone, and where is your estrogen and progesterone—most likely progesterone—that needs to be looked at, right? And vascular health as well. So it's a different approach I think when you're in the 60s, kind of a whole approach with the idea that things can still be reversed.

That's super exciting. That's actually music to my ears to hear you say that because that gives a lot of hope, I think, to people who are listening to this episode. All right, Dr. Lavarusha decided to throw us a curveball and hit Leonard with the 70s. The 70s.

Yeah.

Uh, just go hang out with friends and have a good time. No, I mean, because I think that's what Frank was going to really tell people was have a nice glass of wine, make sure you're eating good food and you're around good friends and family.

But no, at 70, I think it's movement. I think the older you get, the more even more important it is, and just staying active and using your brain. I would say it'd be a lot based around walking, staying moving, and doing new things, playing card games, making sure your mind's active.

I know that the same story happens a lot with grandparents where they get to a point where the family feels like they can't take care of themselves and they want to think about getting them help. And that's where we always see the massive, massive decline happens really fast—is that they have to stay doing things, they have to stay active. Because the second that they start getting that help is where I see the cognitive decline go really sharp. And so finding ways to be in social groups, talking to people, learning new things, moving is going to be the most important thing.

Leonard, could I also just say one of the things I'm taking away from this conversation is the point you made about editing your medicine cabinet for these older folks? It might have been Frank, but you guys were talking about how many of those... some of these cognitive declines really could just, you know, if someone would take the time to go through everything they've been prescribed, right? I mean, I have aging parents and that's something that I'm really going to sort of take a second look at and think about. So, yeah.

Yeah. Take a look because, you know, they get a lot of itchiness. There's a lot of antihistamines that they get prescribed. There's a lot of things that you wouldn't even think of that you would think that are just, you know, for nothing. And especially their cumulative effect. And so, this is the role of the pharmacist. You know, the pharmacist is supposed to be looking out for these things.

But unfortunately, that retail pharmacist at like a CVS or Walgreens is just so busy because they don't have any help that the screen blinks at them red warning like, "Hey, by the way, check this. By the way, check this." But there's always a button you can click to get past that warning sign.

And so it takes someone like you saying, "Hey, I want an evaluation of everything that's in your medicine cabinet." And you know what? With AI, you know, not to... I don't want to say that we can replace the pharmacist with AI, but it's a great place to start if you can't find somebody, because the cumulative effect on just a couple things hitting a certain type of pathway, especially these little antihistamines... you know, they get itchy, they have allergies, they have seasonal allergies, all of a sudden they're taking a couple antihistamines and something else, and the cumulative effect can really impact their cognitive function.

Well guys, this has been one of the funner episodes that I remember and I really, really have to say that there was tons of great information in this. And if you're listening to this right now, you have a loved one who you're concerned about or you just want to improve your family's lives, please share the episode with them, please remember to like, share, and subscribe. And we'll see you on the next episode. Thanks everyone.